NPIMap

Individual provider Active NPI

Julian Richard Luetmer, PA-C

  • Surgical Physician Assistant
  • Saint Cloud, MN
National Provider Identifier
1902151228
Registry record updated Oct 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
11189 Issued in MN
Practice address
1200 6TH Ave N
Centra Care Clinic
Saint Cloud, MN 56303-2735
Phone
(320) 252-3322
NPI assigned
Jul 24, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 1762 MN
Surgical Physician Assistant 363AS0400X 11189 MN Primary

Addresses

Primary practice location

1200 6TH Ave N
Centra Care Clinic
Saint Cloud, MN 56303-2735

Mailing address

1200 6TH Ave N
Centra Care Clinic
Saint Cloud, MN 56303-2735
Phone (320) 252-3322

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121029000192 MN Practitioner - Physician Assistant 8729238787 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1200 6TH Ave N
Saint Cloud, MN 56303-2735

1200 6TH N Ave
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

1406 6TH Ave N
St Cloud, MN 56303-1901

1406 6TH Ave No
St Cloud, MN 56303-1901

Hospital & facility affiliations

  • Centracare - St. Cloud Hospital Hospital, Saint Cloud, MN, CCN 240036

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1762MNMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Health System-NR LLC CurrentSince Sep 1, 2019 Accepting new patients
Centracare Clinic CurrentSince Dec 9, 2013 Accepting new patients
Centracare Clinic CurrentSince Dec 9, 2013 Accepting new patients
Centracare Health-Paynesville LLC CurrentSince Jan 1, 2018 Accepting new patients
Centracare Health System - Sauk Centre CurrentSince Jan 1, 2018 Accepting new patients
Centracare Health System - Long Prairie CurrentSince Jul 1, 2018 Accepting new patients
Centracare Clinic Past Accepting new patients
Centracare Clinic Past Accepting new patients

Locations

815 2nd St SE
Little Falls, MN 56345
Phone (320) 632-5441

50 Centracare Dr
Long Prairie, MN 56347
Phone (320) 732-2131

525 Main St W
Melrose, MN 56352
Phone (320) 256-4228

1013 Hart Blvd
Monticello, MN 55362
Phone (763) 271-2303

200 W 1st St
Paynesville, MN 56362
Phone (320) 243-3767

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

425 Elm St N
Sauk Centre, MN 56378
Phone (320) 352-2221

Interoperability endpoints

  • Direct secure messaging: jluetmer166631@direct.centracare.com

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381708800000",
    "number": "1902151228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 6TH AVE N",
            "address_2": "CENTRA CARE CLINIC",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032735",
            "telephone_number": "320-252-3322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 6TH AVE N",
            "address_2": "CENTRA CARE CLINIC",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032735",
            "telephone_number": "320-252-3322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUETMER",
        "first_name": "JULIAN",
        "middle_name": "RICHARD",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-24",
        "last_updated": "2013-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": "1762",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": "11189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.